New “glitch”: If you like your hospital, you might not be able to keep your hospital

posted at 5:21 pm on October 31, 2013 by Allahpundit

On how he would evaluate the Obama presidency so far:
[Jimmy Carter]: “He’s done the best he could under the circumstances. His major accomplishment was Obamacare, and the implementation of it now is questionable at best.”

Americans who sign up for Obamacare will be getting a big surprise if they expect to access premium health care that may have been previously covered under their personal policies. Most of the top hospitals will accept insurance from just one or two companies operating under Obamacare…

Regulations driven by the Obama White House have indeed made insurance more affordable – if, like Health and Human Services Secretary Kathleen Sebelius, you’re looking only at price. But responding to Obamacare caps on premiums, many insurers will, in turn, simply offer top-tier doctors and hospitals far less cash for services rendered…

“Many companies have selectively entered the exchanges because they are concerned that (the exchanges) will be dominated by risky, high-using populations who wanted insurance (before Obamacare) and couldn’t afford it,” said Wilsensky, who is also on the board of directors of UnitedHealth. “They are pressed to narrow their networks to stay within the premiums.”

Consumers, too, will struggle with the new system. Many exchanges don’t even list the insurance companies on their web sites. Some that do, like California, don’t provide names of doctors or hospitals.

Turns out you can’t expand coverage, cap patient costs, and expect providers to work for less, just like you can’t create the conditions for a major adverse selection problem and expect insurers to flood into the new market. “Some hospitals and doctors don’t even know if they are in the network,” says one expert, a point also made in the WSJ story I flagged this morning about consumers often having no idea who’ the providers are in each plan offered on the state exchanges. That’s not a newly discovered “glitch,” either; the NYT noticed two weeks ago that asking people to comparison-shop among dozens of different plans without telling them which doctors accept which ones leaves them in the dark about a key consideration of their coverage. Essentially, if you’re trying to decide between three or four different plans, the only way to tell if a provider accepts any or all of them is either to call various doctors you’d like to see and run through it with them (imagine being the receptionist fielding hundreds or thousands of those calls) or go to the individual corporate website, find the plan you’re interested in, and then hunt around on the site to see if a particular doctor carries it. This is, of course, the opposite of what the online exchanges were supposed to do; the whole point was to allow for simple, one-stop shopping where you can compare the particulars of different plans side by side.

From what I can tell, the feds’ solution to the provider problem thus far has been simply to not talk about it. Which makes sense from a PR standpoint: Given all the other flaming wreckage they have to deal with, why force the issue of coverage networks being smaller than everyone anticipated until it’s absolutely necessary, i.e. on January 1, when coverage takes effect? It’s irresponsible, though, insofar as they’re pushing consumers to focus on the cost and comprehensiveness of the coverage they’re buying on the exchanges and that’s going to lead them to overlook the provider-network component, which will end up being a nasty surprise later in some cases. You’ve got middle-class people deciding to buy Plan A instead of Plan B because the former’s a bit more affordable and meanwhile, unbeknownst to them, the fine print says that Plan A includes far fewer providers than Plan B does. If you think the media’s been tough on O-Care lately, wait until January when “rate shock” segues into “provider shock.”

Blowback

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I heard a doc I work with, a former president of the state medical society, on the radio this morning saying that United had axed ALL of the cardiologists in Southeastern Connecticut from it’s Medicare Advantage plans. They have informed the doctors but not the patients.

If you have a United Advantage plan, the nearest plan cardiologist is an hour away in Hartford. (Assuming that they’ll stay in the plans any longer than they have too.)

But hey, this is all better isn’t it? I’m sure these folks are all enjoying their free birth control.

The wife has 35 years in coding at hospitals.The new records program EPIC is about to kick in.It will eat the docs up with all of the reporting requirements to the government.She says the docs will be allowed 20 min.per patient and the rest of their time on the computer.She knows many that are throwing in the towel.EPIC is one more knife in the heart of healthcare in this country.

docflash on October 31, 2013 at 6:31 PM

It’s not EPIC’s reporting requirements-it’s the government’s. EPIC is actually one of the best record systems around. The main hospital I work at now uses Cerner which is indescribably bad. One patient I actually timed-3 minutes patient contact 39 minutes with the computer.

I just got called that a patient we accepted in transfer yesterday expired. They sent him up without most of his test results. I actually called two different places at the transferring hospital to try to get them, but they said they weren’t able to print out the test results to send them with the patient or fax them.
We were set up to repeat some of the tests today but the patient didn’t make it. I’m not sure that electronic records represent a change for the better.

New York doctors are treating ObamaCare like the plague, a new survey reveals.

A poll conducted by the New York State Medical Society finds that 44 percent of MDs said they are not participating in the nation’s new health-care plan.

Another 33 percent say they’re still not sure whether to become ObamaCare providers.

Only 23 percent of the 409 physicians queried said they’re taking patients who signed up through health exchanges.

Three out of four doctors who are participating in the program said they “had to participate” because of existing contractual obligations with an insurer or medical provider, not because they wanted to.

Only one in four “affirmatively” chose to sign up for the exchanges.

Athos on October 31, 2013 at 5:29 PM

If you read that survey closely, the “one in four “affirmatively” chose to sign up” is out of the 23% participating. So really less than 6 percent of doctors surveyed are participating.

The next thing to look at with the docs that are left on the list is can you pronounce their names. Where are these docs from and where did they get their training. Maybe they slept in a Holiday Inn Express last night.

And (without reading through the comments) all of that bit about providers isn’t even addressing what happens when that smaller network becomes crowded because of all those people getting booted off their plans and jumping into Obamacare. So, network (supply) shrinks, enrollment (demand) increases… anyone out there remember what happens on that silly economic graph thingy? It’s something to do with prices……..

It is worse than that. Here, NONE of the policies cover the top cancer center or Children’s Hospital (if the policy buyer is over 30, for some reason). So, if you get cancer and are diagnosed at one of the local hospitals that are covered by ObamaCare, they now routinely refer you to the university based cancer center. Not any more. You will be left to fend for yourself at the local hospital which in many cases, does not have the technology or staff to help you. Many expensive technologies, like proton machines, are only available at these cancer centers. You will be out of luck. My wife was diagnosed with lung cancer at a local hospital. They told her it was inoperable and to basically, go home and write her will and maybe this experimental clinical trial might buy some time. We went to the major cancer center and found it was operable and three years later, she is still cancer free. She would be dead under these guidelines. If you like your cancer, your can keep it.

We haven’t started to see the last of the shoes to drop from this EpicClusterFark….

Centrally managed marketplaces do not work. In the long run, we’re going to look at one of Stalin’s 5 Year Economic Plans as a better measure of accuracy and reality than the ACA is…

Richard Nixon resigned over smaller lies than the one’s used by Barack Obama to seize control of 1/6th of the national economy…the only thing we are missing today is a John Dean who is willing to put ‘doing the right thing’, integrity, character, and honesty ahead of loyalty to a party, an individual, or an ideology.

HH: So I don’t understand how 900,000 Californians don’t have their insurance as of 1/1/14, and 1.75 million Americans and counting don’t have their insurance, and the government has the right to come in and bigfoot them all, and having done so on the basis of a lie, Michael. Defend that to me.

MH: In a couple of leaps of logic there. I mean, 900,000 people who had policies that didn’t conform to the standards that are set under the Affordable Care Act. You know, you don’t know that 900,000 people loved their insurance and were dying to keep it. And in fact, as I wrote today, the fact of the matter is that just a few weeks ago or a few months ago, the theme of all the coverage in all the press, including the conservative press about the health insurance industry in this country was that people hated it.

HH: Michael, that’s not what I’m saying. I’m saying he sold a bill of goods. He lied to people. That was, this was part of every…

BO: Here’s the guarantee that I’ve made. If you have insurance that you like, then you will be able to keep that insurance.

HH: What is it about the left that cannot understand people don’t like to be lied to, and now they’re screwed, many of these people, not all of them, many of them will not have insurance in January, and that subset of them that has a catastrophic accident or an occurrence of an illness will suffer potential bankruptcy. Why don’t you understand he did that?

MH: Well, what you just said is utterly untrue. The fact of the matter is, is that the whole point of the Affordable Care Act to improve access to insurance, and that’s what it does, and that all of those people who are losing, whose old policies are being cancelled, they’re being cancelled, and rightly so, because they’re substandard, because they don’t actually provide the protections that people need. And you know that and I know that.

HH: Oh, God, no, I don’t. I just think, I think you live in a different universe, and that you really have no idea about freedom. You have no appreciation…I’m passionate, Michael, because you’ve closed yourself off, literally. I know what the left thinks. I know about negative externalities. But you have no clue about freedom. None.

Read the entire interview – it reflects the viewpoint and knee-jerk defense of the ACA, and to me, an effort of Hiltzik not to report on the experiences of Deborah Cavallaro, but to try to spin / influence / discredit Cavallaro’s experiences and opinions with regards to the reality of the ACA.

It is as fundamentally dishonest as the President was with his lies to ‘sell’ the ACA – you can keep your plan, you can keep your doctor, it will be affordable – when all it is is a government seizure of 1/6th of the national economy, a big government boondoggle masking a massive wealth redistribution effort, and a direct assault on individual freedom and rights – because the individual is too stupid (in their minds) to make decision in their own best interests.

While on the stump, Obama told a multitude of lies about the ACA. A couple of particulary disturbing ones were about his mother.
“So I know what it’s like to see a loved one suffer not because they’re sick but because of a broken healthcare system” Obama during a 3/08 PA stump speech.
Then during the 2nd Presidential debate with McCain, he said this: “For my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.”
The problem here is that Obama’s mother’s Primary healthcare insurance covered all claims for her cancer except for the deductibles and co-pays. She then filed a claim for those additional expenses with her employer’s disability insurance policy. It was this claim which was rejected, after insurance investigators determined she had a pre-existing condition. It was not her actual health insurance claims but a supplemental disability claim.“I will never forget my own mother, as she fought cancer in her final months, having to worry about whether her insurance would refuse to pay for her treatment.” Obama during a towhall in 8/09
This true story was in a biography of Obama’s mother and when given an opportunity to ammend his comments, a WH spokeperson replied “The president has told this story based on his recollection of events that took place more than 15 years ago.”Obama cannot claim ignorance because he acted as his mother’s lawyer when she went to small claims court with the disability insurance company. (for a few hundred dollars)To use his mother’s struggle with cancer, subsequnt death as a lie to the American people indeed dastardly. Of course, as the quotes show, his lawyerly prowess allowed him to infer it was her primary insurance claims which were denied. Wonder why this was never reported????

To use his mother’s struggle with cancer, subsequnt death as a lie to the American people indeed dastardly. Of course, as the quotes show, his lawyerly prowess allowed him to infer it was her primary insurance claims which were denied. Wonder why this was never reported????